We are 20-odd years in the future, in a luxurious dacha in a birch forest southwest of Moscow. A forgetful old man, with wisps of grey hair, recalls his life in fitful bursts “like a momentary flickering of stars lighting up across a darkening, dying galaxy”. The patient is Vladimir Putin.

Former doctor Michael Honig’s curious new novel explores the degenerative effects of endemic corruption. At its centre is a middle-aged nurse, Nikolai Sheremetev, derisively nicknamed “Saint Nikolai”, who seems to be the last man in the country to realise something is rotten in the state of Russia.

The bafflingly innocent Sheremetev must finally acknowledge the nature of the world around him when his beloved nephew, Pasha, is imprisoned. It will take a huge bribe to buy him out because Pasha’s jailers will never believe that an uncle who works for someone that people are calling “the biggest crook in Russia” could be satisfied with a meagre nurse’s salary. The dacha, where all but Sheremetev siphon off their small share of Vladimir’s world-class wealth, is – of course – a microcosm of the country.

As Sheremetev grapples with his moral dilemma, the ex-president’s own ghosts are circling. Characters and events from the past are more real to this reimagined Vladimir Vladimirovich (known throughout by his first name, sometimes with patronymic) than the confusing present.

Honig uses hallucinatory flashbacks to set out the barbarous high points of this fictional 30-year reign: rigging elections, murdering journalists, jailing dissidents, skimming billions from budgets for the Olympics and World Cup, waging wars; an olfactory spectre of the Chechen terrorists he threatened to kill “on the toilet” haunts him. He even admits to ordering “a bomb or two in an apartment building” to encourage appetite for another war. He holds imaginary dialogues with thinly disguised oppositionists, who accuse Vladimir of “embezzlement, propaganda, lies … intimidation” while he rehearses political cliches: “Only a strong man can rule Russia”; “Every problem in Russia is the fault of the west”.

The Senility of Vladimir P is more literal than comparable Russian fiction; in Russia, satire can be dangerous. Dissident journalist Oleg Kashin wrote a dystopian novella (published in English earlier this year as Fardwor, Russia!) in which scientific experiments create legions of overgrown children. Shortly after delivering the book to his publishers, Kashin was savagely beaten and almost killed, probably in response to his political reporting.

Perhaps unsurprisingly, contemporary Russian satire is often fuelled by surreal violence, from Vladimir Sorokin’s powerful Day of the Oprichnik (gang rape, casual murders, drug-fuelled orgies) to Victor Pelevin’s S.N.U.F.F. (sophisticated sex robots, flying killer cameramen filming propaganda). Vladimir P shares these sci-fi elements only to the extent of being set in the near future – eastern Ukraine and northern Belarus have become part of Russia, for example.

Honig’s previous novel, Goldblatt’s Descent, drew directly on his own experience as a doctor to lay bare flaws and frustrations in the NHS. Vladimir P is a very different book, more streamlined and less personal, but both are satires about survival, in which the central character is pitted against an intractable system he despises. Malcolm Goldblatt, a locum registrar in a teaching hospital, watches a junior colleague’s “Hogarthian” progress (“was she sinking into corruption or climbing out of naivety?”) as he grapples with his own moral pressures. Shermetev likewise learns the hard way that “there was no room for softness in Russia”.

Honig’s background has also given him first-hand experience of dementia, a terrible disease “that struck at the core of what made a person who he was”. The deepest part of a person’s character “goes last”; Vladimir’s surviving traits include formidable martial arts’ skills and vanity. He endlessly watches documentaries about himself and tears his top off during an outing to the lake, convinced that it must be a photo shoot. Moments of dark comedy lighten the novel’s grim outlook: Stepanin, the dacha’s irascible, hard-drinking chef, wants to skim off enough money from the dacha to open a Moscow restaurant (“Russian fusion, minimalist decor”). When things go wrong he resorts to his other catchphrase: “fuckery with a cock on top”.

The Senility of Vladimir P is not subtle or stylistically complex, but it readably relates a story worth telling. Many of the events described are happening now and often not so far away. A criminal oligarch has “a beautifully cut suit, probably from London, where his wife, children and two of his mistresses lived”. Vladimir jokes about dissidents having “a habit of dying in London if they’re not careful … it’s that English tea they’re always drinking. There’s more than one way to make it hot.” Since the Litvinenko inquiry recently concluded Putin “probably approved” the radioactive poisoning of his London-based enemy, the hint is accurate and topical.

Preserving a system anywhere that is relatively free of corruption needs vigilance. One of the dacha’s gardeners tells Sheremetev, with suitably horticultural imagery: “If you allow the weeds to grow, they’ll choke off everything.” Honig’s satirical targets include apathy and self-delusion. There is the fatalism that sees real change as impossible: “It was the same in the days of Ivan the Terrible … and it’s the same now,” says the chauffeur. Then there’s the corrosive idea that all politicians are the same: “If it wasn’t Vladimir Vladimirovich who screwed us, it would have been someone else,” claims the chef, downing another shot of vodka. Facts, along with journalists and dissidents, have been casualties of the regime. “A man who tells such lies, for so long,” says the gardener, “… in the end, does he even know the truth himself?”